Declaring the collapse of the U.S. "healthcare" system to be inevitable is akin to declaring the insolvency of the Federal government to be inevitable: unthinkable. Yet both statements are equally true.

The financial impossibility of increasing "healthcare" costs at 6-7% per year in an economy which grows at best 2% (assuming the GDP numbers have any accuracy at all, which is doubtful) is clear; at some point in the near future, the entire GDP of the nation would have to be devoted to "healthcare."

But the system is completely unstable on non-financial levels as well. The entire "employer pays the costs" model is hopelessly divergent from the realities of global wage/benefit arbitrage--the more costs you dump on employers, the more jobs they cut or move offshore-- and the "sickcare for profit" model is intrinsically at odds with the goal of wellness (wellness is unprofitable, managing chronic illness is highly profitable).

Lastly, both the insured and those receiving free Medicaid are totally detached from the cost of their care, and thus from responsibility and choice--the two key features of an adult understanding and response to complex issues.

We turn to correspondent C.P. for a first-hand report on the pervasive sickness of the opaque sickcare system:

I want to commend you for your excellent commentary on healthcare reform. I couldn't agree more and as a former medical scientist I used to have a front row seat, observing in nausea and disbelief the cronyism, horrific waste, ineptness, and outright corruption. The most egregious example being my supervisor's use of our facility and his credentials as the institution's vice president and dean of the medical school to test experimental drugs synthesized by a biotech company he co-owned and held an executive position at.

The vast majority of the funding for the research came from federal grants.

About 8 years ago, in order to make sense of the escalating madness around me and a deep concern that the system was teetering on collapse, I enrolled in a public health and preventive medicine graduate program hoping to participate in a debate on true reform and as a advocate for wellness and prevention rather than the current sickcare paradigm.

To my horror, the program didn't address the core problems and, instead, appeared to be operating as an indoctrination tool for the kind of "reform" recently shoved through Congress. I confronted these issues as best I could during my seminar presentations.

Unfortunately, most docs and researchers were too busy, self-absorbed, or simply brain-washed to appreciate the value of a sustainable alternative to the status quo.

I hit the ejector seat button and my budding career ended. I may be financially poorer for that decision but I'm much more content and intellectually richer in so many ways (and so grateful to have found brilliant writers/thinkers such as yourself!).

BTW, did you happen to read the recent NY Times article on Suzanne Stratton's battle with Carle Cancer Center administrators? In several ways, the errors and cover-ups described in the article are very likely the tip of the iceberg. As the system becomes increasingly opaque, our best bet will be to help educate the public how to be proactive, medically informed self-advocates.

Thank you, C.P., for this report. The people struggling to provide care in such a profoundly contradictory system face unresolvable double-binds. As C.P. notes, they experience an intense indoctrination akin to brainwashing that "this is the best healthcare system in the world" even as they see on a daily basis how the system fails the patients, the caregivers and thus the nation itself.

Frequent contributor Kevin M. (proprietor of the Out of Your Rut blog) questions the system's implicit assumptions made about cures, care and the process of healing:

People get lost in the minutiae of the issue, converting it to a debate that needs to be won, rather than a crisis that needs to be solved. Personally, I think most find the truth to be too disturbing to confront, and somehow find comfort in the details and debates. No matter, that approach will get us nowhere.

This is just my own take on healthcare in general, but while acknowledging that modern medicine has made great strides, we have to wonder if there isn't a large dose of snake oil being peddled too. The failure rate of various treatments have to make them suspect at the very minimum.

Is it possible that a large part of the "cure" that healthcare offers is really nothing more than the hope or belief that a given regimen is or will be successful? Various studies have shown that people of faith live longer and have greater survival rates than those who have no faith--the catch is that faith isn't restricted to one specific belief set. Could it be that many people are cured merely because they have faith that the doctor, medications, surgeries, system, etc, is saving them, and that's the driving force behind many recoveries? As long as they stay on a given therapy, or have hope that another will be offered for what ever may go wrong with them, their faith remains intact, and the power of the mind--not so much the threrapy--is what actually produces the cure.

I believe this may be true for millions of elderly, who are on multiple drug therapies and have a virtual umbilical cord to the healthcare system. Many have seen their bodies deteriorate well past the point of functionality, but something keeps them alive. That something may be their own minds and the faith they have in the healthcare system to save them, rather than the system itself.

At one level, we can see benefit to such a collective placebo affect; the problem is in it's enormous and unrestricted cost.

I'm with you that well-care will be the key to any program coming down the pike, and until it becomes the driving force of healthcare, any program we can hatch will be little more than reshuffling the deck.

Thank you, Kevin. Providing well-care is not what the present system is designed to do or incentivized to do; therefore it is incapable of doing so.

I think the model of vast Federal bureaucracies solving every citizen's problems is inherently insolvent and irredeemably broken. Well-care will have to come from a wellspring of individual responsibility and small-scale community effort, not some gigantic institutional machine which stripmines the entire economy to feed its voracious and insatiable appetite for more money to fund a crazymaking jumble of completely perverse incentives.

Wellness requires an integrated understanding of the oneness of food, diet, fitness, physical and mental health and the culture which sustains or erodes this understanding; without this full-spectrum understanding, then well-care will remain forever beyond reach.

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